Nurse-Led Multi-Strain Probiotic Adjunctive Therapy in Patients with Colorectal Cancer: Effects on Psychological Distress, Inflammatory Responses, and Quality of Life

Abstract

Objective: To evaluate the effects of a nurse-led multi-strain probiotic adjunctive therapy on psychological distress, inflammatory responses, and quality of life in patients with colorectal cancer.

Methods: This quasi-experimental, two-group pretest–posttest study was conducted at RSUD Siti Fatimah Provinsi Sumatera Selatan, Palembang, Indonesia, from March to July 2026. A total of 70 patients with colorectal cancer were consecutively recruited and allocated to an intervention group receiving nurse-led multi-strain probiotic adjunctive therapy plus standard CRC care (n=35) or a control group receiving standard CRC care alone (n=35). Psychological distress, inflammatory biomarkers, and quality of life were assessed before and after the intervention. Between-group differences in outcome changes were evaluated using baseline-adjusted analyses.

Results: The intervention group demonstrated a greater reduction in psychological distress than the control group, with HADS scores decreasing from 16.9 ± 4.8 to 11.2 ± 4.1 versus 17.2 ± 5.1 to 15.3 ± 4.8, respectively. The between-group difference in mean change was −3.8 points (95% CI: −5.3 to −2.3; p<0.001). CRP, IL-6, and TNF-α decreased more substantially in the intervention group, with between-group differences of −2.8 mg/L (95% CI: −4.2 to −1.4; p<0.001), −2.7 pg/mL (95% CI: −4.2 to −1.2; p=0.001), and −1.7 pg/mL (95% CI: −2.6 to −0.8; p<0.001), respectively. Global health status improved by 10.9 points more than in the control group (95% CI: 6.6–15.2; p<0.001), with additional improvements in functional status and colorectal cancer-related symptoms.

Conclusion: Nurse-led multi-strain probiotic adjunctive therapy was associated with improvements in psychological distress, inflammatory responses, and quality of life among patients with colorectal cancer. These findings support its potential as a complementary component of holistic CRC care, although larger randomized controlled trials are warranted to confirm its effectiveness.